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Individual

DR. KENNETH M WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
700 BELLEVUE ST SE, SUITE 260, SALEM, OR 97301-3819
(503) 375-3636
(503) 375-3737
Mailing address
PO BOX 1168, CANBY, OR 97013-1168
(936) 777-2255

Taxonomy

Speciality
Code
Description
License number
State
2086S0105X
Surgery of the Hand (Surgery) Physician
Primary
MD16217
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
045336
OR
Enumeration date
07/17/2006
Last updated
07/23/2013
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